NPIMap

Individual provider Active NPI

Derek Anthony Gallucci, D.O.

  • Family Medicine Physician
  • Williamsville, NY
National Provider Identifier
1346508991
Registry record updated Apr 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
279555 Issued in NY
Practice address
30 N Union Rd Ste 102
Williamsville, NY 14221-5367
Phone
(716) 839-8000
NPI assigned
May 1, 2012
Last updated
Apr 26, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 279555 NY Primary

Addresses

Primary practice location

30 N Union Rd Ste 102
Williamsville, NY 14221-5367

Mailing address

30 N Union Rd Ste 102
Williamsville, NY 14221-5367
Phone (716) 839-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150724010854 NY Practitioner - Family Practice 6204149818 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Care of Western New York LLPGroup PAC ID 5193746832, 36 clinicians

Practice addresses (Care Compare)

2780 Delaware Ave
Kenmore, NY 14217-2748
Phone (716) 839-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care of Western New York LLP Family Medicine CurrentSince Aug 1, 2015 Accepting new patients
Digestive Health Physicians, P.C. Past Accepting new patients

Locations

2780 Delaware Ave
Ste 201
Kenmore, NY 14217
Phone (716) 839-8000

30 N Union Rd
Williamsville, NY 14221
Phone (716) 633-6363

30 N Union Rd
Ste 102
Williamsville, NY 14221
Phone (716) 839-8000

Interoperability endpoints

  • Direct secure messaging: derekg@primarycarewny.medentdirect.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461628800000",
    "number": "1346508991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N UNION RD STE 102",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142215367",
            "telephone_number": "716-839-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N UNION RD STE 102",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142215367",
            "telephone_number": "716-839-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLUCCI",
        "first_name": "DEREK",
        "middle_name": "ANTHONY",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-01",
        "last_updated": "2016-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "279555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.